Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Is ipsilateral systematic biopsy combined with targeted biopsy the optimal substitute for bilateral systematic biopsy combined with targeted biopsy: A systematic review and meta-analysis","authors":"Qiyou Wu M.D. ,&nbsp;Xiang Tu Ph.D. ,&nbsp;Jinjiang Jiang Ph.D.,&nbsp;Jianjun Ye Ph.D.,&nbsp;Tianhai Lin Ph.D.,&nbsp;Zhenhua Liu Ph.D.,&nbsp;Lu Yang Ph.D.,&nbsp;Shi Qiu Ph.D.,&nbsp;Bo Tang Ph.D.,&nbsp;Yige Bao Ph.D.,&nbsp;Qiang Wei Ph.D.","doi":"10.1016/j.urolonc.2024.11.023","DOIUrl":"10.1016/j.urolonc.2024.11.023","url":null,"abstract":"<div><h3>Background</h3><div>The current standard prostate biopsy method, which combine systematic biopsy (SB) with targeted biopsy (TB), has shortcomings such as overdiagnosis and overtreatment. To evaluate the effectiveness of ipsilateral systematic biopsy (ips-SB) combined with targeted biopsy (ips-SB+TB) and contralateral SB (con-SB) combined with TB (con-SB+TB) as potential alternatives to SB+TB.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in Cochrane, Embase, Ovid, and PubMed databases until September 2024. 2,732 references were identified, and 11 records were included.</div></div><div><h3>Main findings</h3><div>The study included a total of 5,249 patients and revealed that ips-SB+TB detected slightly less PCa than SB+TB with a relative risk (RR) of 0.95 (95% CI 0.91, 1.00), <em>P</em> = 0.05. In terms of csPCa detection, ips-SB+TB showed a comparable detection rate with SB+TB (RR 0.98 [95% CI 0.94, 1.01], <em>P</em> = 0.60). There was a statistically significant difference in csPCa detection between con-SB+TB and SB+TB (RR 0.92 [95% CI 0.86, 0.99], <em>P</em> = 0.02). The detection rates of clinically insignificant PCa (ciPCa) were comparable between con-SB+TB vs. SB+TB (con-SB+TB vs. SB+TB: RR 0.90 [95% CI 0.79, 1.04], <em>P</em> = 0.15). However, fewer ciPCa cases were detected in ips-SB+TB compared to SB+TB (RR 0.86 [95% CI 0.75, 0.99], <em>P</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>In this review, our analysis highlights ips-SB+TB has the comparable detection efficiency of PCa and csPCa compared to SB+TB, and its potential to be the substitute of the SB+TB with less cores and less detection of ciPCa.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 307-317"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate second resection versus restage transurethral resection of bladder tumor: A prospective randomized clinical trial (IMMERSE trial)","authors":"Shritosh Kumar M.Ch. ,&nbsp;Rishi Nayyar M.Ch. ,&nbsp;Siddharth Jain M.Ch. ,&nbsp;Amlesh Seth M.Ch. ,&nbsp;Seema Kaushal M.D.","doi":"10.1016/j.urolonc.2024.12.276","DOIUrl":"10.1016/j.urolonc.2024.12.276","url":null,"abstract":"<div><h3>Background</h3><div>The role of repeat transurethral resection of bladder tumor (TURBT) for the management of nonmuscle invasive bladder carcinoma is debated, especially when initial resections include detrusor muscle. This study compares immediate second resection (additional deep biopsies in the same session) with standard restage TURBT performed 2–6 weeks post-initial TURBT to determine adequacy in detrusor muscle sampling and compare the disease rate at restage TURBT in both groups.</div></div><div><h3>Material and Methods</h3><div>A randomized trial was conducted at a tertiary care hospital, including patients aged ≥18 years undergoing TURBT with complete primary tumor resection. Cases were randomized into two groups i.e., ‘standard TURBT’ (complete tumor resection with a deep biopsy) and “immediate second resection” (complete tumor resection, deep biopsy and additional deep biopsies). The primary endpoint was the presence of detrusor muscle in biopsy specimens, analyzed by a single pathologist. Secondary endpoints included perioperative complications, residual/ recurrent tumors, and factors affecting these recurrences.</div></div><div><h3>Result</h3><div>The study included 83 patients: 44 in the 'standard TURBT' group and 39 in the 'immediate second resection' group. The detrusor muscle was present in 66% of standard TURBT cases and 97% of immediate second resection cases, showing a statistically significant improvement (<em>P</em> = 0.000). Residual disease was found in 41% of restage TURBT patients in the standard group and 15% in the immediate second resection group, the majority being high-grade and T1 tumors (<em>P</em> = 0.028). There were no significant differences in tumor grade or perioperative complications between the groups. However, immediate second resection showed 18% higher detrusor muscle sampling rates than standard re-stage TURBT done at 2–6 weeks (<em>P</em> = 0.021).</div></div><div><h3>Conclusion</h3><div>Immediate second resection at the time of initial TURBT significantly improves detrusor muscle sampling rates and decreases residual tumors at restage. Despite higher muscle sampling, a considerable proportion of patients still exhibited residual or recurrent tumors in both groups, emphasizing the need for improved detection and biopsy techniques during primary TURBT.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 331.e9-331.e16"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern and risk factors of local recurrence and intravesical recurrence after segmental ureterectomy for upper tract urothelial carcinoma","authors":"Bao Guan ,&nbsp;Silu Chen ,&nbsp;Zihao Tao ,&nbsp;Yueyuan Jiang ,&nbsp;Zhenyu Li ,&nbsp;Chunru Xu ,&nbsp;Gengyan Xiong ,&nbsp;Qi Tang ,&nbsp;Yang Liu ,&nbsp;Hongzhen Li ,&nbsp;Xianshu Gao ,&nbsp;Liqun Zhou ,&nbsp;Xuesong Li ,&nbsp;Xiaoying Li","doi":"10.1016/j.urolonc.2025.03.008","DOIUrl":"10.1016/j.urolonc.2025.03.008","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the pattern and risk factors of local recurrence and intravesical recurrence of ureteral upper tract urothelial carcinoma (UTUC) following segmental ureterectomy (SU).</div></div><div><h3>Methods</h3><div>From February 2012 to August 2021, a retrospective analysis was conducted on patients following SU. Univariate and multivariate Cox regression analysis were used to evaluate the risk factors. Kaplan–Meier curves were employed to illustrate survival outcomes.</div></div><div><h3>Results</h3><div>Among 88 patients, 50 (57%) were male, with a median age of 71 (IQR: 62–77) years. The procedures of ureteral reconstruction included ureteral reimplantation in 77 (88%) cases, ureteroureteral anastomosis in 9 (10 %) cases, Boari flap ureteroplasty with psoas hitch in 1 (1%) case, and cutaneous ureterostomy in 1 (1%) case. The median follow-up time was 44.5 months. The 3-year rate of local recurrence, lymph node metastasis, ipsilateral upper urinary tract recurrence and intravesical recurrence was 31.6%, 19.0%, 22.2% and 35.7%, respectively. G3 (HR = 3.355, 95% CI 1.375–8.184, <em>P</em> = 0.008), and lymphatic vascular infiltration (HR = 3.127, 95% CI 1.043–9.373, <em>P</em> = 0.042) were independent risk factors for local recurrence. G3 (HR = 3.782, 95% CI 1.036–13.812, <em>P</em> = 0.044) was an independent risk factor for lymph node metastasis. Sarcomatoid differentiation (HR = 3.943, 95% CI 1.087–14.308, <em>P</em> = 0.037) was an independent risk factor for ipsilateral upper urinary tract recurrence. Previous or concurrent bladder cancer (HR = 3.280, 95% CI 1.667–6.453, <em>P</em> = 0.001) and sarcomatoid differentiation (HR = 4.442, 95% CI 1.317–14.989, <em>P</em> = 0.016) were independent risk factor for intravesical recurrence. The most common regions for bladder recurrence were posterior wall (21%), same lateral wall (16%) and trigon (16%).</div></div><div><h3>Conclusion</h3><div>SU is a feasible treatment for selected UTUC patients, yet it is associated with a considerable risk of local and intravesical recurrence. Careful monitoring and active adjuvant therapy are essential to minimize the recurrence rate for patients with risk factors.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 330.e11-330.e17"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urologic oncology case volume among early career urologists: An analysis of certification data from the American board of urology between 2003 and 2019","authors":"Devki Shukla M.D. ,&nbsp;Max J. Hyman B.A. ,&nbsp;Piyush K. Agarwal M.D. ,&nbsp;Sarah Faris M.D. ,&nbsp;Ted A. Skolarus M.D., M.P.H. ,&nbsp;Parth K. Modi M.D., M.S.","doi":"10.1016/j.urolonc.2024.09.034","DOIUrl":"10.1016/j.urolonc.2024.09.034","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;We examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63–0.92, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48–2.78, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34–2.58, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and MIS radical prostatectomy (80.4% with fellowship training vs. 45.0% without fellowship training, OR 1.69, 95% CI 1.16–2.48, &lt;em&gt;P&lt;/em&gt; = 0.006). When comparing those with solely oncology specialization to those with both oncology specialization and fellowship training, we found that those with oncology fellowship training had over 2 times higher odds of performing open radical cystectomy (OR 2.58, CI 1.78–3.74, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), open radical nephrectomy (OR 2.06, CI 1.42–2.99, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and open radical prostatectomy (OR 2.12, CI 1.44–3.12, &lt;em&gt;P&lt;/em&gt; &lt; 0.001). Female urologists had significantly lower odds of performing each oncologic procedure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this analysis of early career urologist case logs, the proportion of urologists performing a radical cystecto","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 335.e9-335.e15"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor location at trans-urethral resection is predictive of ipsilateral pelvic lymph-nodal metastases in patients undergoing radical cystectomy for bladder cancer","authors":"Francesco Cianflone,&nbsp;Giovanni Mazzucato,&nbsp;Emanuele Rubilotta,&nbsp;Rossella Orlando,&nbsp;Nicola De Maria,&nbsp;Michele Boldini,&nbsp;Francesca Fumanelli,&nbsp;Francesca Montanaro,&nbsp;Greta Pettenuzzo,&nbsp;Luca Roggero,&nbsp;Alessandra Gozzo,&nbsp;Alberto Bianchi,&nbsp;Alessandro Veccia,&nbsp;Riccardo Giuseppe Bertolo,&nbsp;Maria Angela Cerruto,&nbsp;Alessandro Antonelli","doi":"10.1016/j.urolonc.2024.09.037","DOIUrl":"10.1016/j.urolonc.2024.09.037","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether tumor location at diagnostic TURBT is predictive of ipsilateral nodal involvement in patients who underwent radical cystectomy (RC) with lymph-nodes dissection for bladder cancer (BCa).</div></div><div><h3>Materials and methods</h3><div>All patients who underwent RC for BCa at a single institution between 2014–2023 were assessed. Tumor location at TURBT was defined as right-sided, median-line, left-sided, and diffused. Distribution in the percentage of ipsilateral positive lymph-nodes and number of ipsilateral positive lymph-nodes between tumor locations were assessed with Kruskal-Wallis tests. Linear regressions were fitted to assess whether left or right location, compared to the remaining locations grouped, was associated to the percentage and number of positive ipsilateral lymph-nodes.</div></div><div><h3>Results</h3><div>239 patients were included. The number of ipsilateral positive lymph nodes was superior in right-sided tumors when compared to the rest of the bladder (0, I.Q.R. 0–1 vs. 0, I.Q.R. 0–0, <em>P</em> = 0.047), as well as the percentage of ipsilateral positive lymph-nodes (0, I.Q.R. 0–14.3 vs. 0, I.Q.R. 0–3.7, <em>P</em> = 0.042). The number of ipsilateral positive lymph-nodes in left-sided tumors was superior when compared to the rest of the bladder (0, I.Q.R. 0–1 vs. 0, I.Q.R. 0–0, <em>P</em> = 0.02), as well as the percentage (0, I.Q.R. 0–13.7 vs. 0, I.Q.R. 0–0, <em>P =</em> 0.036). At linear regression analyses, right- and left-sided tumors were associated with an increased percentage of ipsilateral positive lymph-nodes (<em>P =</em> 0,019 and <em>P =</em> 0,003) out of the total ipsilateral lymph-nodes excised.</div></div><div><h3>Conclusions</h3><div>Lateral wall tumor location at diagnostic TURBT (either right or left side) predicts a higher percentage of ipsilateral positive lymph-nodes s/p RC.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 331.e1-331.e7"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Clinician interest in clinical decision support for PSA-based prostate cancer screening” [Urol Oncol: Semin Original Investigat. 41(3) March 2023, 145.e17-145.e23]","authors":"Jonathan Harper B.A. ,&nbsp;Trevor C. Hunt M.D. ,&nbsp;Mouneeb Choudry B.S. ,&nbsp;Ashley L. Kapron ,&nbsp;Kathleen A. Cooney M.D. ,&nbsp;Christopher Martin M.D. ,&nbsp;Jacob Ambrose M.S. ,&nbsp;Brock O'Neil M.D.","doi":"10.1016/j.urolonc.2025.03.010","DOIUrl":"10.1016/j.urolonc.2025.03.010","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Page 338"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective evaluation of comprehensive geriatric assessments in multidisciplinary bladder cancer care and implications for personalized vulnerability phenotyping.","authors":"Dana Cavanaugh, Sarah K Holt, Erin Dwyer, Erin Petersen, John L Gore, George R Schade, Petros Grivas, Andrew C Hsieh, John K Lee, Bruce Montgomery, Michael T Schweizer, Todd Yezefski, Evan Y Yu, Jonathan J Chen, Jay J Liao, Emily Weg, Jing Zeng, Samia Jannat, Donna L Berry, Viraj A Master, Jose M Garcia, May J Reed, Itay Bentov, Jonathan L Wright, Sarah P Psutka","doi":"10.1016/j.urolonc.2025.03.025","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.025","url":null,"abstract":"<p><strong>Purpose: </strong>Frailty predicts adverse outcomes in bladder cancer (BC). Current guidelines endorse completion of Comprehensive Geriatric Assessments (CGAs) in older adults prior to treatment election to objectively measure frailty, however, these are rarely performed in urologic practice due to inadequate resources. We hypothesized CGA implementation would be feasible and identify multifaceted vulnerabilities beyond standard risk assessments in a multidisciplinary BC clinic and developed a novel method to visualize \"vulnerability phenotypes\" to guide supportive interventions.</p><p><strong>Methods: </strong>Adults with BC were prospectively enrolled (June, 2020-July, 2021). Initially, patients underwent standard of care (SOC) risk assessment (N = 27). Subsequently, patients completed CGAs augmented with body composition assessments (N = 67). CGA completion time, rates, and patient-reported burden were assessed. Interdependence of CGA domains were quantified using Spearman correlation coefficients and compared decisional conflict and regret between arms. Vulnerability phenotypes were visualized using Spider Plots, generated in R. Clinical and survival associations with CGAs were evaluated using Cox proportional hazards models.</p><p><strong>Results: </strong>94 patients were enrolled with a median age of 72 years. Instrument completion in the CGA cohort was 79% to 100%. 91% of patients reported CGA completion was at most minimally burdensome. CGAs identified vulnerabilities including 31% vulnerable-to-moderately frail, 21% with mild-to-severe depression, 3% with mild-moderate dementia, and 40% at risk for malnutrition-malnourished. Frailty measures across instruments were weakly correlated (rho <0.4). In this heterogeneous cohort, vulnerability domains were not significantly associated with decisional conflict/regret, survival, nor complication rates after treatment. A novel Spider Plot tool is proposed to facilitate communication of the dominant vulnerability-driving individual risks.</p><p><strong>Conclusions: </strong>CGAs can be successfully incorporated into uro-oncology practice with low perceived burden, identifying key vulnerabilities with implications for clinical care. Weak correlations across instruments support the value of gathering information across discrete domains. We present a novel approach to visually characterize personalized vulnerability phenotypes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world treatment patterns and outcomes of patients with unresectable or metastatic urothelial carcinoma receiving systemic therapy in Japan","authors":"Shotaro Yasuoka MD ,&nbsp;Toshihiko Minegishi MS ,&nbsp;Shingo Kojima BP, PMP ,&nbsp;Kotoba Okuyama MS ,&nbsp;Toshiki Fukasawa MS ,&nbsp;Mizuho Akahane MD ,&nbsp;Hidetoshi Uenaka PhD ,&nbsp;Yuichiro Ito MD, PhD ,&nbsp;Makito Miyake MD, PhD","doi":"10.1016/j.urolonc.2024.09.020","DOIUrl":"10.1016/j.urolonc.2024.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Cisplatin-based chemotherapy has traditionally been the standard treatment for unresectable or metastatic urothelial carcinoma (mUC). Recently, the longstanding paradigm has changed with the emergence of immune checkpoint inhibitors and antibody-drug conjugates, such as pembrolizumab and enfortumab vedotin (EV). This longitudinal descriptive study aimed to identify real-world treatment patterns and assess the outcomes of patients with mUC between 2010 and 2023.</div></div><div><h3>Methods</h3><div>Patients with mUC who received first-line systemic therapy were identified from a Japanese electronic medical records database. A Sankey diagram was used to present the proportion of patients who transitioned to second- and third-line therapies. Kaplan–Meier survival analysis was used to estimate the time to next treatment (TTNT) and overall survival (OS).</div></div><div><h3>Results</h3><div>A total of 794 patients were included in this study. The median age of the patients was 73.0 years, and 72.9% were male. The most common primary tumor site was the bladder (59.7%). First-line therapy comprised cisplatin-based regimens in 52.0% of the patients (11.8% at standard doses, 32.4% at reduced doses, and 7.8% at unknown doses), carboplatin-based regimens in 32.1%, and other regimens in 15.9%. Among the patients enrolled after 2017, following the approval of pembrolizumab for mUC progressing after chemotherapy in Japan, 58.2% received pembrolizumab as second-line therapy, and 19.1% received EV monotherapy as third-line therapy. The median OS for the total population was 24.1 months, with patients enrolled between 2010 and 2016 having a shorter OS (21.1 months) than those enrolled between 2017 and 2022 (24.9 months). For patients with eGFRs of ≥60 and &lt;60 mL/min/1.73 m², the median OS was 24.1 and 23.8 months, respectively.</div></div><div><h3>Conclusion</h3><div>Platinum-based regimens, including reduced-dose cisplatin and carboplatin, remain the predominant first-line systemic therapies. Since 2017, pembrolizumab and EV have become widespread choices for second-line and subsequent treatments, gradually surpassing the previously prevalent platinum-based regimens. The introduction of these novel therapies might have prolonged the OS of patients with mUC. A plain language summary is available in this article.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 329.e1-329.e8"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Attainment of early, deep prostate-specific antigen response in metastatic castration-sensitive prostate cancer: A comparison of patients initiated on apalutamide or enzalutamide’[Urol Oncol: Semin Original Investigat 41(3) (2023) 253.e1-253.e9]","authors":"Benjamin Lowentritt ,&nbsp;Dominic Pilon ,&nbsp;Ibrahim Khilfeh ,&nbsp;Carmine Rossi ,&nbsp;Erik Muser ,&nbsp;Frederic Kinkead ,&nbsp;Dexter Waters ,&nbsp;Lorie Ellis ,&nbsp;Patrick Lefebvre ,&nbsp;Gordon Brown","doi":"10.1016/j.urolonc.2025.03.011","DOIUrl":"10.1016/j.urolonc.2025.03.011","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Page 339"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ preservation and oncological efficacy of peniscopically controlled CO2 laser excision of penile squamous cell carcinoma: Early and late results in a high-volume center","authors":"Sebastiano Nazzani M.D., Ph.D. ,&nbsp;Vito Lorusso M.D. ,&nbsp;Mario Catanzaro M.D. ,&nbsp;Tullio Torelli M.D. ,&nbsp;Carlo Silvani M.D. ,&nbsp;Alberto Macchi M.D. ,&nbsp;Davide Biasoni M.D. ,&nbsp;Ruggero Darisi M.D. ,&nbsp;Claudia Colbacchini M.D. ,&nbsp;Silvia Stagni M.D. ,&nbsp;Antonio Tesone M.D. ,&nbsp;Melanie Claps M.D. ,&nbsp;Patrizia Giannatempo M.D. ,&nbsp;Matteo Zimatore M.D. ,&nbsp;Laura Cattaneo M.D. ,&nbsp;Emanuele Montanari M.D. ,&nbsp;Nicola Nicolai M.D.","doi":"10.1016/j.urolonc.2025.02.024","DOIUrl":"10.1016/j.urolonc.2025.02.024","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate safety and early and long-term efficacy of CO₂ laser conservative treatments for nonulcerative squamous cell carcinoma (SCC) of the penis.</div></div><div><h3>Material and Methods</h3><div>Within our institutional database (2002–2022, included), we identified 122 consecutive cT1-2 cN0 cM0 patients with penile SCC who underwent conservative CO₂ laser treatments. Histologically confirmed local relapses were recorded. Local relapses were classified as early recurrences when occurring &lt;2 years and as late new tumor recurrences when occurring &gt;2 years after first laser treatment. Predictors of disease relapse were analyzed with univariable and multivariable Cox regression models (MCRMs).</div></div><div><h3>Results</h3><div>Median follow-up was 36 months [Interquartile range (IQR) 21-73 months]. Median age was 62 years (IQR: 51-69 years). Median largest lesion size was 10 mm (IQR 5-15 mm). 62 patients had penile intraepithelial neoplasia (PeIN) (51.6%), 30 had pT1 m (24.6%), 28 had pT1 (23%) and 1 had pT2 (0.8%), 2 patients were classified as pTx. In case of invasive lesions, tumor Grade was G1 in 37 (60.7%), G2 in 20 (32.8%), G3 in 4 (6.5%). Early and late recurrences occurred in 28 (22%) and in 21 patients (18%), respectively. Proportion of penis preservation was 93.4% and 92.6% at 2 and 5 years. pT1 stage [Hazard Ratio (HR) 13, Confidence Interval (CI) 1.4-73, p-value 0.02] and flat lesions (HR 7.9, CI 1.06-59, 0.04) achieved independent predictor status for late recurrences. No cancer related deaths were recorded after a median follow-up of 36 months.</div></div><div><h3>Conclusions</h3><div>As far as we know, this is the largest cohort of patients with penile cT1-T2 SCC who underwent conservative CO₂ laser treatment. The vast majority (92%) of these patients preserved their organ at 5 years. Some factors can be of use in preventing or anticipating late recurrences.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 337.e23-337.e30"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}